Return to learning after a concussion and compliance with recommendations for cognitive rest

Objective: To determine the compliance of schools and school nurses in the United States with national recommendations for cognitive rest in students who sustain a concussion. Design: Cross-sectional questionnaire based. Participants: Members of the National Association of School Nurses working at the high school level. Intervention: A questionnaire, developed by the authors and based on recommendations for cognitive rest, was electronically distributed 3 times during the 2012 to 2013 academic year. Main Outcome Measures: Self-reported responses were collected regarding demographics and compliance of schools and school nurses with recommendations for the management of the postconcussion student, including the presence of specific guidelines for individualized care and the responsibility of the nurse for the prevention, detection, and management of concussions. Results: Analysis was performed on 1033 completed questionnaires (36% usable response rate). Fifty-three percent of schools have guidelines to assist students when returning to school after a concussion. These guidelines include extension of assignment deadlines (87%), rest periods during the school day (84%), postponement or staggering of tests (75%), reduced workload (73%), and accommodation for light or noise sensitivity (64%). Sixty-six percent of nurses in our sample have had special training in the recognition and management of concussions. Nurses reported involvement in the following roles: identifying suspected concussions (80%), providing emotional support for recovering students dealing with concussionrelated depression (59%), and guiding the student's postconcussion graduated academic and activity re-entry process (58%). Conclusions: We detected a wide variability in compliance of schools and school nurses with national recommendations for cognitive rest. Clinical Relevance: Ensuring that schools have policies established for a student's return to learning, having specific guidelines to provide an individualized approach to return to learning based on postconcussion signs/symptoms, training school nurses in the recognition and management of concussions, and involving school nurses in the re-entry process are identified areas for improvement. Schools in the United States should be aware of these recommendations to guide a student's postconcussion graduated academic re-entry process.